Adapted strategy to tumor response in childhood nasopharyngeal carcinoma: the French experience

Jouin, A.; Helfre, Sylvie; Bolle, Stéphanie; Claude, L.; Laprie, A.; Bogart, Émilie; Vigneron, C.; Potet, H.; Ducassou, A.; Claren, Audrey; Riet, F.-G.; Castex, Marie Pierre; Faure‐Conter, Cécile; Fresneau, Brice; Defachelles, Anne‐Sophie; Orbach, Daniel

doi:10.1007/s00066-019-01461-6

Cited by 25 publications

(52 citation statements)

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“…Due to these diverging approaches resulting in different target volumes, the comparison of data remains challenging [18][19][20]. There were no general recommendations for the irradiation of metastases within NB 97 and NB 2004 and the indication for RT to metastatic lesions was based on individual decisions, forming a risk for selection bias [21]. Additionally, in our cohort a significant number of lesions did not receive RT, which might be a reason for our low survival rates.…”

Section: Discussionmentioning

confidence: 85%

Long-term follow-up of children with neuroblastoma receiving radiotherapy to metastatic lesions within the German Neuroblastoma Trials NB97 and NB 2004

et al. 2020

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Purpose Neuroblastoma (NB) is the most common extracranial solid malignancy during childhood. Despite a multimodal treatment approach, the prognosis of patients with metastatic NB is not satisfactory. Although radiotherapy (RT) has become an integral part of treatment of the primary tumor, the role of RT in osteomedullary lesions is not well defined. A retrospective analysis was conducted to evaluate the impact of RT for metastatic sites in children with high-risk NB. Methods All patients with stage 4 NB from the prospective, multicenter NB trials NB97 and NB2004 who received RT to metastatic sites during frontline treatment were included in this retrospective analysis. Results A total of 18 children were irradiated with a median dose of 36 Gray (Gy; range 20–45 Gy) to one or more (range 1–3) osteomedullary metastases with or without concomitant RT to the primary tumor site. The median follow-up time was 149 months (range 55–220) in survivors. At 5 years, local relapse-free survival (LRFS) at irradiated metastatic sites and metastases-free survival (MFS) at distant, non-irradiated site rates were 51.4 and 39.9%, respectively. The estimated overall survival (OS) rate at 5 years was 49.4%. No high-grade acute or late toxicity and no secondary malignancy was reported. Conclusion RT to metastases is feasible for patients with stage 4 NB. However, an impact of RT to residual metastatic sites on outcome was not found. Studies with larger cohorts or prospective trials would be desirable in order to elucidate the role of RT for metastases.

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Section: Discussionmentioning

confidence: 85%

Long-term follow-up of children with neuroblastoma receiving radiotherapy to metastatic lesions within the German Neuroblastoma Trials NB97 and NB 2004

et al. 2020

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“…To our knowledge, RiSK was the only prospective registry for recording acute and late effects of radiotherapy in childhood and adolescence. The documentation was carried out by qualified radio-oncologists and based on standardized medical follow-up examinations, which is crucial for the aftercare of specific side effects [31]. Therefore, the data from the RiSK must be considered objective with regard to eye damage.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of treatment-associated eye toxicity after irradiation in childhood and adolescence—results from the Registry of the Evaluation of Side Effects after Radiotherapy in Childhood and Adolescence (RiSK)

et al. 2021

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Purpose The aim of the study is to evaluate treatment-related acute and late eye toxicity associated with radiation therapy in childhood and adolescence as correlated with RT (radiotherapy) doses. Methods From 2001 to 2016, a total of 1725 children and adolescents undergoing radiation therapy were prospectively documented in the Registry of the Evaluation of Side Effects after Radiotherapy in Childhood and Adolescence (RiSK). The RTOG/EORTC criteria were used to classify ocular acute and late effects. Uni- and multivariate analyses were carried out to evaluate the impact of patient age, pre-existing impairments, and radiation dose on ocular toxicity. Results Of all documented patients, 593 received dose to the eye and formed the basis of this analysis. In 435 patients, information on acute reaction was available and graded 1, 2, 3, and 4 in 49, 17, 0, and 2 patients, respectively. Information on late toxicity was available in 268 patients and graded 1, 2, 3, and 4 in 15, 11, 11, and 5 patients, respectively. The acute toxicity rate was significantly higher in children who received a maximum dose > 50 Gy to the eye (p < 0.001) and who had a pre-existing eye impairment (p < 0.001 in multivariate analysis). The development of late toxicity was significantly higher for patients experiencing acute toxicity and having received a radiation dose > 50 Gy. Conclusion Acute and late toxicity both correlate with high radiation dose to the eye (> 50 Gy) and acute toxicity additionally with pre-existing eye impairments.

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“…The combination of radiotherapy and chemotherapy significantly improved outcomes . Recent studies using cisplatin‐based induction and concurrent chemotherapy with radiation demonstrated 5‐year survival of 70‐90% (Table ) . Buehrlen et al conducted a prospective multicenter study (NPC‐2003GPOH/DCOG) using three courses of induction chemotherapy with cisplatin and 5‐FU followed by response‐adapted radiotherapy of 54‐59.4 Gy with concomitant cisplatin .…”

Section: Discussionmentioning

confidence: 99%

Proton therapy following induction chemotherapy for pediatric and adolescent nasopharyngeal carcinoma

Uezono

Indelicato

Rotondo

et al. 2019

Pediatric Blood & Cancer

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Purpose In children treated for nasopharyngeal carcinoma, proton therapy and postchemotherapy target volumes can reduce the radiation dose to developing tissue in the brain and the skull base region. We analyzed outcomes in children with nasopharyngeal carcinoma treated with induction chemotherapy followed by moderate‐dose proton therapy. Methods/Materials Seventeen patients with nonmetastatic nonkeratinizing undifferentiated/poorly differentiated nasopharyngeal carcinoma underwent double‐scattered proton therapy between 2011 and 2017. Median age was 15.3 years (range, 7‐21). The American Joint Committee on Cancer T and N stage distribution included the following: T1, one patient; T2, five patients; T3, two patients; and T4, nine patients; and N1, six patients; N2, nine patients; and N3, two patients. Median radiation dose to the primary target volume and enlarged lymph nodes was 61.2 Gy (range, 59.4‐61.2). Uninvolved cervical nodes received 45 Gy (range, 45‐46.8). All radiation was delivered at 1.8 Gy/fraction daily using sequential plans. In 11 patients, photon‐based intensity‐modulated radiotherapy was used for elective neck irradiation to optimize dose homogeneity and improve target conformity. All patients received induction chemotherapy; all but one received concurrent chemotherapy. Five received adjuvant beta‐interferon therapy. Results Median follow‐up was 3.0 years (range, 1.6‐7.9). No patients were lost to follow‐up. Overall survival, progression‐free survival, and local control rates were 100%. Fifteen patients developed mucositis requiring enteral feeding (n = 14) or total parenteral nutrition (n = 1) during radiotherapy. Serious late side effects included cataract (n = 1), esophageal stenosis requiring dilation (n = 1), sensorineural hearing loss requiring aids (n = 1), and hormone deficiency (n = 5, including three with isolated hypothyroidism). Conclusion Following induction chemotherapy, moderate‐dose proton therapy can potentially reduce toxicity in the brain and skull base region without compromising disease control. However, further follow‐up is needed to fully characterize and evaluate any reduction in long‐term complications.

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Adapted strategy to tumor response in childhood nasopharyngeal carcinoma: the French experience

Cited by 25 publications

References 50 publications

Long-term follow-up of children with neuroblastoma receiving radiotherapy to metastatic lesions within the German Neuroblastoma Trials NB97 and NB 2004

Long-term follow-up of children with neuroblastoma receiving radiotherapy to metastatic lesions within the German Neuroblastoma Trials NB97 and NB 2004

Evaluation of treatment-associated eye toxicity after irradiation in childhood and adolescence—results from the Registry of the Evaluation of Side Effects after Radiotherapy in Childhood and Adolescence (RiSK)

Proton therapy following induction chemotherapy for pediatric and adolescent nasopharyngeal carcinoma

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